A comparison between epidural anaesthesia using alkalinized solution and spinal (combined spinal/epidural) anaesthesia for elective caesarean section

Patel, Manesh R.; Craig, R.; Laishley, R.S.

doi:10.1016/s0959-289x(96)80043-4

Cited by 12 publications

(4 citation statements)

References 20 publications

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“…Median (IQR [range]) time to reach a block to touch to T5 was 7 (6-9 [5][6][7][8][9][10][11][12][13][14][15][16][17]) min for lidocaine-bicarbonate-adrenaline and 14 (10-17 [9-31]) min for levobupivacaine. Time to reach a block to cold to T4 was also faster with lidocaine-bicarbonate-adrenaline (7 (5-8 [4][5][6][7][8][9][10][11][12][13][14][15][16][17]) min than with levobupivacaine (11 (9-14 [6-30]) min; p = 0.001). Epidural supplementation before the start of surgery was required only in the levobupivacaine group, although this difference was not statistically significant ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Few data have been published on onset times with lidocaine for emergency Caesarean section. Lam et al reported a block to pinprick to T6 within a mean (SD [range]) of 5.2 (1.5 [2][3][4][5][6][7][8]) min of an epidural top-up with lidocainebicarbonate-adrenaline with 75 lg fentanyl; the onset time without bicarbonate was 9.7 (1.6 [6][7][8][9][10][11][12]) min [14].…”

Section: Discussionmentioning

confidence: 99%

“…We have found that trainees rotating to our unit often report the use of a lidocaine‐bicarbonate‐adrenaline mixture in other units when a faster onset of block is required, for example when there is fetal compromise. This mixture has been described in the literature for both elective [8–11] and emergency [12–14] Caesarean section, and anecdotal contact with non‐UK anaesthetists suggests that this mixture is also widely used around the world. However, although addition of bicarbonate to lidocaine results in rapid onset of anaesthesia for elective Caesarean section [11] and speeds the onset of lidocaine when used for extending labour analgesia for emergency Caesarean section [14], we are unaware of any studies of topping up an epidural for emergencies that compare lidocaine‐bicarbonate mixtures with other agents available in the UK, although lidocaine without bicarbonate has been found to have no advantage over bupivacaine in this situation [3, 15].…”

mentioning

confidence: 99%

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Epidural lidocaine‐bicarbonate‐adrenaline vs levobupivacaine for emergency Caesarean section: a randomised controlled trial*

Allam¹,

Malhotra

Hemingway³

et al. 2008

Anaesthesia

110

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SummaryEpidural mixtures containing lidocaine with or without additives are commonly used to convert epidural analgesia in labour to anaesthesia for emergency Caesarean section, but direct comparisons with alternative, single agents in this situation are few. In a prospective double-blinded trial, we compared a freshly prepared lidocaine-bicarbonate-adrenaline mixture (final concentrations 1.8%, 0.76% and 1 : 200,000, respectively) with our standard agent, levobupivacaine 0.5%, for extending epidural blockade for emergency Caesarean section. Using a sequential analysis technique, with data analysed in blocks of 40, women receiving epidural analgesia in labour who required top-up for Caesarean section were randomly assigned to receive 20 ml of epidural solution over 3 min. The first analysis (n = 40) indicated that the study should be stopped, as significant differences were found in our primary outcome data. Median (IQR [range]) times to reach a block to touch to T5 and cold to T4 were, respectively, 7 (6-9 [5-17]) min and 7 (5-8 [4-17]) min for lidocainebicarbonate-adrenaline, and 14 (10 )17 [9-31]) min and 11 (9-14 [6-30]) min for levobupivacaine (p = 0.00004 and 0.001, respectively). Pre-and intra-operative supplementation ⁄ pain, maternal side-effects and neonatal outcomes (excluding five women who underwent instrumental delivery) were similar between the groups. Intra-operative maternal sedation (scored by the mother on a 10-point scale) was greater with lidocaine-bicarbonate-adrenaline (4.5 (3-8 [1-9])) than with levobupivacaine (3 (1-4 [1-7])), but not significantly so (p = 0.07). We conclude that epidural lidocaine-bicarbonate-adrenaline halves the onset time when extending epidural analgesia for Caesarean section although there is a possibility of increased maternal sedation. When extending epidural analgesia in labour for emergency Caesarean section, the most appropriate choice of local anaesthetic for achieving rapid and reliable epidural anaesthesia remains unclear. A recent survey of leading UK obstetric anaesthetists [1] found that 13 combinations of local anaesthetics and adjuncts are used in this situation, with 2% lidocaine (alone or in combination) used by 40% of respondents and 0.5% levobupivacaine or bupivacaine used by 72% of respondents (some respondents using more than one in their practice). In our unit, levobupivacaine is the standard agent used in this situation and was adopted as a result of previous studies that showed no consistent advantage of alternatives [2][3][4], and because of the superior safety profile of levobupivacaine compared with bupivacaine [5,6]. Use of levobupivacaine has recently been recommended as best practice when extending epidural analgesia for emergency Caesarean section [7].We have found that trainees rotating to our unit often report the use of a lidocaine-bicarbonate-adrenaline mixture in other units when a faster onset of block is required, for example when there is fetal compromise.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Epidural lidocaine‐bicarbonate‐adrenaline vs levobupivacaine for emergency Caesarean section: a randomised controlled trial*

Allam¹,

Malhotra

Hemingway³

et al. 2008

Anaesthesia

110

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“…Because commercial preparations of lidocaine are acidic [3], increasing the pH towards the physiological range can theoretically increase the speed of onset. This was shown in previous studies in which sodium bicarbonate was added to lidocaine [3–5]. However, most of these studies were conducted in elective settings or on patients who were not in labour; limited data are available for emergency cases in which the rapid establishment of anaesthesia may be more important.…”

mentioning

confidence: 99%

Extension of epidural blockade in labour for emergency Caesarean section using 2% lidocaine with epinephrine and fentanyl, with or without alkalinisation*

Lam¹,

Kee

Khaw

2001

Anaesthesia

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In a randomised, double-blind study, we investigated rapid extension of epidural analgesia to surgical anaesthesia for emergency Caesarean section. Parturients receiving epidural analgesia in labour who subsequently required Caesarean section were given a test dose of 3 ml lidocaine 2% with epinephrine 1 : 200 000, followed 3 min later by 12 ml lidocaine 2% with epinephrine 1 : 200 000 and fentanyl 75 microg, to which was added 1.2 ml sodium bicarbonate 8.4% (bicarbonate group; n = 20) or saline (saline group; n = 20). Mean (SD [range]) time to surgical anaesthesia was less in the bicarbonate group (5.2 (1.5) [2-8] min) than the saline group (9.7 (1.6) [6-12] min; mean difference 4.5 min (95% CI 3.5-5.5) min; p < 0.001). Maternal side-effects and neonatal outcome were similar between groups. We conclude that pH-adjusted lidocaine 2% with epinephrine and fentanyl is effective for rapidly establishing surgical anaesthesia in patients with a functioning epidural catheter for labour who require emergency Caesarean section.

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Mobile epidural techniques and new drugs in labour

Fernando¹,

Collis²

2000

Regional Analgesia in Obstetrics

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A comparison between epidural anaesthesia using alkalinized solution and spinal (combined spinal/epidural) anaesthesia for elective caesarean section

Cited by 12 publications

References 20 publications

Epidural lidocaine‐bicarbonate‐adrenaline vs levobupivacaine for emergency Caesarean section: a randomised controlled trial*

Epidural lidocaine‐bicarbonate‐adrenaline vs levobupivacaine for emergency Caesarean section: a randomised controlled trial*

Extension of epidural blockade in labour for emergency Caesarean section using 2% lidocaine with epinephrine and fentanyl, with or without alkalinisation*

Mobile epidural techniques and new drugs in labour

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